Brain Aneurysm (Cerebral) Surgery Abroad

What is a Brain Aneurysm Surgery?
A brain aneurysm surgery is surgical procedure in which a brain aneurysm is clipped. A brain aneurysm surgery is performed to cut off the bulging vein from the blood supply. This is done by clipping the neck of the bulge, which isolates the brain aneurysm from the rest of the blood circulation. This also prevents it from damaging the surrounding blood vessels, and its size is shrunk in a process called aneurysm obliteration. A brain aneurysm surgery is done as an emergency procedure if the aneurysm ruptures or it is done within 72 hours after a brain aneurysm has been diagnosed in an MRI or CT scan. If the brain aneurysms are less than 3mm, they may not be treated immediately as they pose very less threats to rupture.

Other treatments of brain aneurysms include an endovascular procedure. This is a less-invasive method of brain aneurysm treatment, which uses a catheter to put a coil around the aneurysm to prevent rupture and bleeding.

How is a Brain Aneurysm Surgery Performed?
A brain aneurysm surgery is performed by clipping. Clipping is a brain aneurysm surgery that is performed by a neurosurgeon. The surgery is done in an open craniotomy. During this procedure, the scalp and skull covering the brain is cut open. Then, a metal clip is used to clip the aneurysm base to prevent rupture.

First, the patient needs to lie on the operating table. Once the anesthesia is given and the patient is asleep, the patient’s head is positioned in a three-pin skull fixation machine. The incision area is prepared depending on the location of the brain aneurysm. Cerebrospinal fluid (CSF) may be removed by inserting a lumbar drain in the patient’s lower back. This is done to make the brain relax, for which some medication may also be provided.

Then, a craniotomy is made in the skull depending on the location of the brain aneurysm. The incision is made to expose the skull. The muscle and skin are lifted from the bone and folded back. Tiny burr holes are drilled into the skull. A craniotome, which is a special saw, is entered through the burr holes and an outline is cut. The bone flap that is cut is lifted and taken away, which then exposes the dura mater that is the protective covering of the brain. The bone flap is replaced when the procedure ends.

In the next step, the dura mater is opened and the brain is exposed. A corridor between the skull and the brain is opened by placing retractors on the brain, which is used to trace the aneurysm. Before the aneurysm is clipped, the blood flow to and fro the aneurysm is controlled. After this, the aneurysm is isolated from the surrounding tissues and blood vessels. Then, a clip is placed across the neck of the aneurysm. Many clips may be used for this procedure. The clip is examined to see if it is not confining arteries. A needle is used to puncture the dome of the aneurysm to ensure that blood is not reaching the aneurysm. Once the clipping is done, the retractors are removed and sutures are used to close the dura. The bone flap is set back in its place with titanium plates and screws. The skin and muscles are then closed with sutures. A dressing is used to cover the incision.

How to prepare for the Surgery?
This procedure is often performed on an emergency basis when the aneurysm is ruptured. In this case:

• The patient may be given medication to decrease blood pressure.
• The blood pressure may be monitored with the help of an arterial pressure line inserted through the patient’s arm.

If it is not an emergency:

• The patient needs to give some tests like blood test, electrocardiogram, etc.
• Certain medication that the patient is taking may be stopped.
• An intravenous line is inserted into the patient’s arm.
• The patient will have a discussion with an anesthesiologist about the effects and risks of anesthesia.

Duration of procedure/surgery:
Approximately 3 to 5 hours or longer depending on the complexity of the craniotomy

Days admitted:
Approximately 2 to 3 weeks

Anesthesia:
General anesthesia

Recovery:
- The patients are put in a recovery room after the surgery.
- They are then transferred to the Neurosurgical Intensive Care Unit (NICU) to be monitored for 24 to 48 hours or longer in the case of a ruptured aneurysm.
- After the patients are out of the NICU, they are kept in the neurological floor for about a week. Here the patients are examined in terms of the damage caused by the aneurysm. Rehabilitation may be required for some patients.
- Full recovery is made by some patients however; most of the patients suffer some kind of impairment.

Risks:
The risks of a brain aneurysm surgery include:
- Risks of anesthesia
- Blood clotting
- Swelling of the Brain
- Infection
- Stroke
- Seizure
- Problems affecting speech, vision, memory, balance, coordination, etc.
- Intra-operative rupture

After care:
- Patients with ruptured aneurysms require a longer duration of rehabilitation than patients with un-ruptured aneurysms.
- Rehabilitation involves many types of therapies such as physical therapy, speech and neuropsychological therapy, etc.